Acute Cauda Equina Syndrome in Rapid Succession: A Case Series of Eight Consecutive Patients Undergoing Emergency Surgical Decompression Over One Week.

Introduction: Cauda equina syndrome (CES) is a rare but devastating spinal surgical emergency, most commonly caused by lumbar disc herniation. Delayed diagnosis or decompression may result in irreversible neurological and sphincter dysfunction. Materials and Methods: This retrospective single-Center case series included eight consecutive patients with acute CES who underwent emergency surgical decompression over 1 week at a tertiary spine care center. Clinical presentation, radiological findings, surgical management, and 6-month post-operative outcomes were evaluated. Results: The cohort included six males and two females (mean age: 43.1 ± 9.8 years). Urinary dysfunction was present in all patients; five (62.5%) had CES with retention (CESR) and three (37.5%) had incomplete CES (CESI). Saddle anesthesia and motor weakness were observed in 75% and 62.5% of patients, respectively. L4-L5 was the most commonly involved level. Five patients underwent transforaminal lumbar interbody fusion and three underwent decompression with microdiscectomy. The mean interval from bladder symptom onset to surgery was 26.8 ± 11.4 h. At 6 months, complete neurological and sphincter recovery was achieved in five patients (62.5%), partial recovery in two (25%), and persistent bowel/bladder dysfunction in one (12.5%). Patients with CESI demonstrated better recovery than those with CESR. Conclusion: Early recognition, urgent magnetic resonance imaging, and timely surgical decompression are essential for optimizing neurological and bladder recovery in acute CES. Better recovery was observed among patients presenting with CESI than among those with established urinary retention. These findings reinforce the importance of prompt recognition, urgent diagnostic evaluation, and emergency surgical management before further neurological deterioration.